ABSTRACT The past decade has seen a dramatic shift in the management of lower urinary tract dysfunction, including dysfunctional voiding, in children. Once treated primarily with medication, dysfunctional voiding now is managed successfully in most cases with noninvasive evaluations and biofeedback-based pelvic floor muscle retraining. Introduced in 1979, biofeedback initially was expensive and labor intensive, requiring inpatient treatment. The use of animated computer games has expedited results, allowing excellent resolution of dysfunctional voiding and coexisting conditions such as vesicoureteral reflux and constipation with outpatient treatment. Morbidity from medications and surgical procedures has been reduced at centers using biofeedback. Future goals of biofeedback therapy should include further refinements in technique and increasing access to care.

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To compare the outcomes of the open-ended six to ten sessions of biofeedback against a novel regime of four sessions of biofeedback to treat children with dysfunctional voiding. Patients from two centers using different methods were retrospectively analyzed. Group 1 comprised 20 patients treated with four sessions of biofeedback. Group 2 comprised 20 patients treated with six to ten sessions of biofeedback. Each group was evaluated with subjective and objective parameters pre-treatment, immediately post-treatment and 6 months post-treatment. All patients in Group 1 were treated with four sessions of biofeedback and in Group 2 the mean number of sessions was 7.35 +/- 1.30 (range 6-10). Normalized voiding flow curves after treatment were determined in 18 patients in Group 1 (90 %) and 19 patients in Group 2 (95 %) (p = 0.553). There were seven patients (35 %) in Group 1 and eight patients (40 %) in Group 2 with reflux. When units were compared, there were 11 units (4 bilateral) in Group 1 and 13 units (5 bilateral) in Group 2 with reflux (p = 0.747). At 6 months post-treatment, in Group 1, seven had resolved (63.6 %), three had improved (27.2 %) and one persisted (9.01 %). In Group 2, ten had resolved (76.9 %) and three had improved (23.1 %) (p = 0.553). Biofeedback therapy is one of the most widely used techniques in dysfunctional voiding in children. The regime of use has not been well defined, and the results of this study showed that a regime of four sessions of biofeedback therapy may be as safe and effective as the previously defined open-ended six to ten sessions.

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